This K23 proposal is from a pediatric physician who has a history of a strong interest in oral health in children, and the development of the pediatrician as a positive force in assuring that appropriate attention is paid to oral health in young children. Poor and minority children are disproportionately affected by dental caries and are more likely to have difficulty accessing dental care. Low-income children may have more secure access to regular visits with Primary Care Health Providers (PCHPs). Using the PRECEDE-PROCEED model as a planning framework, this proposal aims to assess the feasibility of a health care model in which PCHPs are substantially involved in oral health. Five interrelated projects seek to determine how PCHPs can successfully expand their scope of practice to include preventive oral health from the provider, practice, and patient-parent perspective. Analysis of Washington State Medicaid claims data will be performed to measure the degree to which PCHPs have unique opportunities to provide preventive oral health counseling and care to their low-income patients who otherwise are not accessing dental care. The final project will be a randomized trial using a pretest-posttest design. The PCHP practices will be randomly selected to participate in an expanded oral health preventive package. Control practices will receive limited intervention. The number of claims submitted to Medicaid for fluoride varnish application, as an indicator of expanded PCHP involvement in preventive oral health, will be compared between treatment and control practices. At the completion of these projects, it is expected to have developed a rich model whereby PCHPs may expand their involvement in preventive oral health as a means to improve access to preventive dental care for underserved and other vulnerable groups of children. In addition, this career development award is expected to provide to Dr. Lewis the didactic and experiential training necessary to become an independent clinical investigator focusing on pediatric and dental health services research.